There is a bizarre boom in plastic surgery in small-town India. NISHITA JHA reports on the frantic search for beauty. Photographs by GARIMA JAIN

IN MAY 2008, we missed a wake up call. For those who were snoozing, this was when Sony Television aired 10 episodes of a reality series called Naya Roop, Nayi Zindagi, based on the American show Extreme Makeovers. If India had ever imagined that botox injections and silicone implants were preoccupations of the rich and the bored, this was our cue to wake up. Naya Roop trawled through small towns recounting the sordid life story of a ‘deformed’ person (victims of burns and acid attacks, obese men, aged women), transformed magically when the channel picked them for a cosmetic surgery makeover. Hosted by Mona Singh of Jassi Jaisi Koi Nahin (Indian television’s most popular makeover), one of the episodes began with a re-dramatisation of Amritsarbased Prasanta Sharma’s accident with a pressure cooker when she was three years old.

Phantom dreams Plastic surgeon Sunil Kalda at his Raipur clinic

Sharma’s mother and sisters appear in turns, talking about how hard it is for Prasanta, a 26-year-old postgraduate in sociology, to find a husband. One day, on a visit to the Wagah border with her family, a voice on a microphone calls Sharma to the centre of the rows of Indian and Pakistani soldiers. An armed officer stands at attention in front of her and barks, “Madam, you have been ordered by Sony Television to have a makeover!” The thousands of strangers at the border erupt into applause. The overwhelmed young woman bursts into tears, sobbing gratefully into a tricolour the guard hands her.

The show came as a shock because it told us smalltown India had ambitions beyond just becoming Indian idols and dancing superstars. Small towns, much like metros, were full of the same advertising-induced fervour for a ‘better’ life — catalysed here through a better face.

Here are the incredible facts: The latest report (2010) by the International Society of Aesthetic Plastic Surgery (ISAPS) places India at No. 4 on the list of plastic surgery hubs in the world. We account for nearly 5.2 percent of the world’s cosmetic surgeries. Our forerunners are knifehappy US, Brazil and China, where the combined charms of Hollywood, leggy models and soap stars have caused a permanent dip in self-esteem. South Korea, which follows us on the list, is already notorious for its sinister ‘Makeover Town’ in Seoul — a strip in the city that offers speedy nip tucks round the clock for half the usual price.

The most popular surgeries in the world — liposuction, breast augmentation, eyelid reconstruction and rhinoplasties (nose jobs) — are finding a new wave of takers across Indian B towns: cosmetic surgery clinics in Lucknow, Thiruvananthapuram and Indore provide tummy tucks for at least 5-6 patients every week. Dr Ravinder Tah of Ludhiana says he’s lost count of how many requests he got for rhinoplasties between 2009 and 2010: “There was a time when people would go to great lengths to hide the fact that they were undergoing cosmetic surgery. That is no longer the case — you still don’t want a gossiping neighbour to find out, but it’s an open secret amongst cousins and family. Female ex-patients often come to me with their daughters-in-law, cousins and aunts, suggesting nips and tucks.” Dr Anup Dhir, chief surgeon with the Apollo Hospitals group in Delhi believes that fewer patients travel to metros for cosmetic surgeries now since most small towns and district centres offer the same services at half the cost. Economics dictates a reverse journey — most small-town clinics witness a flood of medical tourists and desperate patients since their services cost much less. A rhinoplasty that would begin at Rs. 45,000 in a metro comes for less than Rs. 25,000 in Dehradun, Raipur and Patiala. Facelifts that cost Rs. 2 lakh in Delhi can be had for one-fourth the price in Chhattisgarh.

WELCOME TO Raipur. Most metropolitan Indians would know this town only as Chhattisgarh’s rutty capital. The place the media writes of only as a stopover point to India’s mineral-rich and strife-torn heartland — Dantewada, Abujmarh; the Maoist crisis in capital alphabets. But beneath this public reputation, Raipur is a different place altogether. All over town are people dreaming, planning, scheming for nips and tucks that will transform their lives forever.

India is number four on the global list of plastic surgery hubs. We have nearly 5.2 percent of the world’s cosmetic surgeries

Kalda Plastic Surgery and Burn Treatment Centre, a small clinic in a narrow bylane, in a sense epitomises this phenomenon. The Kalda Centre has the flurry of a mall. The clinic is the size of any swanky private nursing home in a metro — and it’s never empty. This is the first of many clues to the local obsession with plastic surgery. From the moment you enter, the walls suggest ways to make you look better. The expected fawning language is evident in the charts and posters: “In True Service of Mankind’s Suffering”; “Cosmetic Surgery — A Positive Life Changing Experience”; “Its about You. Refine and Redefine Yourself”. One chart has 12 rows of before-and-after tummy-tuck photos, another cajoles with a selection of lip enhancements, and the biggest promises better hairlines, bigger breasts, sharper jawlines. The before-after photographs are a mirror to our aspirations — thinner waists, heads full of hair, dimples, and yes, we are still hankering for Cindy Crawford’s mole.

Dr Sunil Kalda, 50, is a mild man with an imperfect nose, who sits in an office surrounded by trophies and certificates. He has a small staff that waits on the unceasing traffic of patients — him, his pathologist wife Neelam, a team of anaesthologists and a few nurses. But from his little kingdom in Raipur, he promises to transform your life. “My aim,” he says, “is to make the patient as attractive as possible. It’s what every one wants.”

Dr Kalda claims he’s performed a mind-boggling 50,000 cosmetic surgeries, nearly 300 liposuctions and six sex change operations. “People said plastic surgery would never get popular in Chhattisgarh, but now, doctors from the UK and Taiwan ask me for case studies for their journals.” To be a skilled cosmetic surgeon, one must have vast experience in reconstructive surgery. Treating patients with extreme physical deformities in nutrition-starved tribal regions has sharpened Dr Kalda’s skills with the knife.

Bollywood remains B-town India’s fantasy, its self image. So while a teenybopper in Vadodara may not have heard of Heidi Montag’s multiple surgeries, you can bet your nose she’s discussed Koena Mitra’s ever-changing face. Dr Kalda recounts many such instances: “A patient came with 200 photos of Aishwarya Rai’s nose. I don’t even know how she got hold of so many pictures, but she had one from every pose and angle. She wanted a nose exactly like that.”

Beauty, however, is only a subset of the desire to belong. Indians aren’t just looking for better looking noses. Jackson, a 20-year-old model from Shillong is considering the infamous eyelid reconstructive surgery that will widen his eyes and permanently set him apart from his small-eyed parents and cousins. Ask him why and he says matter-of-factly, “The way I look is my bread and butter. The fact is that very few north-easterners make it as models — it’s hard because we look different.” After a pause, he adds with a laugh, “In any case, I think my personality is better suited to having big eyes, you know?”

Most commonly, Adivasi clients in Chhattisgarh also ask for their eyes to be widened and for their typically flat noses to be sharpened (they say prospective grooms’ families complain that Bastar and Kotoriya girls look too ‘sleepy’ or ‘chinky’). Women want breast augmentation, men want hair transplants, and both want liposuctions and tummy tucks. Dr Kalda gladly shows off a montage of Bollywood belly buttons that he offers his patients. There are also, of course, skin lightening chemical peels and fairness laser treatments. Like everywhere else in the world, plastic surgery is the sharpest expression of a desire to forget your past. In Raipur most requests for tattoo removals come from upwardly mobile Adivasis who want to assimilate, who want their village names erased from their bodies. Across India, plastic surgery is begetting its own world of plastic people. The ‘mainstream’ is not about the common denominator anymore. It’s about Perfection.

A PLASTIC surgeon’s office is a good place to observe the kites of human dissatisfaction. There are the traditional demands, such as hymenoplasty — which creates a fake ‘virgin hymen’ (a gelatin membrane filled with blood-like substance in the vagina) to ensure bleeding after intercourse. And there are newer ones, like the mother who came to Dr Kalda from Uttar Pradesh to get her new daughter-in-law a complete makeover of six painful procedures — a reshaped forehead, a nose-job, new cheekbones, an altered jawline (which involves breaking the jaw for remodelling), breast implants (that will need to be removed for breast feeding) and butt implants. Comments Dr Kalda, “The saas examined the girl’s naked body before marriage and brought her to me so she could be perfect for her son.” It’s the highest number of procedures the good doctor has performed on a single patient, save those who get a sex change.

The Ash effect Patients often bring images of Bollywood stars to get body parts modelled on them

There are those who want to be plastic brides or grooms, others who want to match their partners’ bodies and some who just want plasticity for themselves. Many young couples vie to ‘improve’ their partner’s appearance and are heavily targeted in newspaper advertisements around Valentine’s Day.

2) 40-50-year-olds trying to switch jobs and compete with younger peers in interviews.

3) Post 50-year-olds anxious about occasions like a college reunion or a silver wedding anniversary.

Age is no longer a deterrent to obsessing about your appearance. This plastic world sneers at the idea that ‘after marriage you can let yourself go’. Whether anxious about cheating spouses or simply because they now have enough time and money to fret over their bodies, married women of all ages frequent Dr Kalda’s clinic.

Ankita Dube, 43, wife of a paediatrician, first visited Dr Kalda’s clinic in Raipur for a fairness chemical peel for her daughter’s wedding. Among other things, she’d revealed her anxiety to Dr Kalda that she suspected her husband of cheating on her. The doctor had suggested breast implants to counter this threat, and so there followed a second visit where she went from 34 B to 36 C.

A month after the surgery, now that the scars have begun to heal, Dube is both coy and excited on the phone: “People are looking at me differently. I was afraid of the risk. I hadn’t told my husband that I sold a pair of gold bangles to get the surgery. But now he doesn’t want to leave my side. That’s not a big price to pay for a loyal husband. You know what men are like,” she adds with a giggle, “it’s difficult to keep them interested.” As he watched Dube leave his office, Dr Kalda said with an indulgent smile, “Sometimes I get the feeling that some women are here because they got bored of visiting parlours and spas.”

The powerful post-op gratification — I finally look like I deserve to — is often short-lived. Dube may be back soon. Someone like Nirmala Kumari, 55 and married to a coldstorage owner, shows signs of a kind of addiction. Kumari, visiting Dr Kalda’s clinic in Raipur with her 32-year-old son Satish, is here because her ring finger has developed a strange discolouration. The doctor suspects a blood clot. But when he returns to examine her after seeing a patient in another room, she says in a voice trying its best to remain casual, “Doctor, I think my earlobes have become too elongated. Can you fix them with surgery after you fix my finger?” The procedure will involve removing an earlobe section (stretched by years of heavy earrings), reshaping the lobes and sewing up the slit created by the stretched piercing. Kumari makes her request sound like she was asking a tailor to tighten a loose-fitting blouse.

Not all cosmetic surgery is sought so flippantly. Pinky, 16, doesn’t want to talk to anyone. She is fighting with her mother Reena, her father Ram Singh and her brother Raju. She’s been fighting with them for two years, when her life changed in a single, burning moment. That day two years ago, Ram Singh, a furnace worker in a steel factory in Chhattisgarh, and his 10-year-old son Raju were waiting by their plates while Pinky and her mother cooked dinner. In a moment of clumsiness Pinky dropped the bottle of kerosene into the chulha, causing flames to shoot up and engulf her body. The family reacted fast. Within seconds she was on the floor wrapped in her mother’s shawl while her father and brother doused the resulting fire — but it was too late. “It is a mother’s worst nightmare,” says Reena between emerging tears, “to have a daughter who you know no one will marry.”

Pinky suffered third degree burns on her torso, arms and neck, while her face had minimal scarring. When the family rushed her to a local hospital in Bhilai, doctors managed to treat the most severely burnt parts and she was able to return to school in 10 months. But her happy recovery was cut short when Pinky’s parents pulled her out of school — Ram Singh had sold all his valuables and taken a huge loan from his boss for his daughter’s treatment, and he had no money left to pay her school fees. A healthy daughter who topped her class and was learning to smile again wasn’t enough; instead, her father needed to make sure she was fit to snare a husband. Singh heard that the only way to ensure the impossible was a visit to Dr Kalda’s clinic.

Gori scene A patient waits her turn to get a fairer skin and chiselled body

Now, Pinky and her mother visit the clinic every month with a meagre sum that Ram Singh earns at the steel factory and Raju gets from odd jobs. Reena pitches in, tailoring clothes in Bhilai. Depending on the amount collected that month, Dr Kalda surgically grafts healthy skin upon small patches of Pinky’s damaged parts. After almost a year of this, her face and neck are entirely scar-free and only the injuries on her arms and legs remain. Now, more than ever, she wants her parents to stop scrimping for surgeries and let her return to school. Reena is defensive about their decision — “Her father and I always wanted her to finish school, we know how important it is.” She directs her words resentfully at her glaring daughter and continues, “But who will explain to her how important it is that she have someone to look after her when we are gone?” Pinky, rolls her eyes at her mother’s emotional logic. When Reena leaves her for barely five seconds, she mutters tersely, “If she let me go to school, I could pay for my own surgery and I wouldn’t need anyone to look after me.” Her rage is contagious.

JOAN COLLINS famously said the problem with beauty is that it’s like being born rich and getting poorer. Wrinkles, deposits of fat or unwanted hair are enough to cause severe depression among patients, say doctors. Given the high premium we now put on how we look, it’s no surprise that patients feel plastic surgery is almost like sorcery — “Usually, no psychological therapy is necessary because patients need only look into a mirror post-operation to feel like a new person. You’d be surprised at how even something as basic as their walk changes after getting a new nose or lighter skin,” agrees Dr KM Kapoor, a Chandigarh-based surgeon.

Dr Kalra of Dehradun is the rare plastic surgeon who says he refuses to touch patients who expect miracles. “You have to be realistic,” he says. “When young girls bring me a picture of Katrina Kaif, asking for total body contouring to look like her, I have to say no — because there is no humanly possible way to satisfy such a demand. These are cases of body dysmorphia. These girls need counselling, not surgery.” To most surgeons, though, the need for surgery is directly proportional to the patient’s desire. Take Dr Kalda, who expounds in paternal cadences, “You can’t say that someone with a snub nose needs surgery less than someone with a birth defect. To someone who thinks their nose is ugly, even a functional body part can be crippling to their lives and confidence. I always tell my patients that shyness doesn’t help you get a good body or face, but if you are honest with your surgeon, everything is possible.”

‘I sold my gold bangles to get surgery. That’s not a big price to pay for a loyal husband. You know what men are like,’ giggles Dube in Raipur

While this advice is doled out to everyone who visits his clinic — labourers, babies (Dr Kalda has treated babies as young as nine months for skin discolourations on parents’ demands), housewives, college-going PYTs, MLAs, Chhattisgarh movie stars — a reciprocal honesty is harder to find. Weak and outdated laws mean full doctor disclosure is still rare in the plastic clinics and spas that have mushroomed across the land. Facelifts can cause nerves to lose sensitivity altogether and go numb. Pain, numbness, bruising and de-pigmentation usually follow liposuctions. The body often reacts to breast implants by developing a fibrous capsule around the foreign matter, while leakage of silicone gel (gel bleeds) can be fatal. Patients report that little or no mention is made of these dire after-effects and risks. Most are not even aware why they suddenly plunge into post-surgical depression (caused when their tissue retains the chemicals used for general anaesthesia).

Most patients who ask for tummy-tucks have sedentary lifestyles. While doctors unanimously agree that obesity can be controlled with 10 minutes of yoga, a healthy diet and a daily brisk walk, they don’t hesitate in offering a short-term, short-cut surgical solution — to cut open patients’ stomachs and have pipes suck the fat out. Even Dr Kalda, who’s convinced that cosmetic surgery transforms deeply hurt people into joyfully fulfilled beings, has often had cases where the same patient keeps requesting surgeries on different body parts. The problem is, Dr Kalda doesn’t view this as body dysmorphia — he applauds his patients for taking proactive steps to improve their life. In the green, neon-lit dystopia of a plastic clinic, you risk being inducted into his ‘optimism’. He sees no reason to worry. According to him, the incline in number of patients seeking plastic surgery is because people are taking more pride in their appearance. They are bringing in their aged parents for liposuction or minor corrective surgeries because they are heeding a ‘call of conscience’.

Naturally, there are also patients who undergo plastic surgery for physical defects that impede their functioning — such as not being able to breathe, hear, swallow or enjoy sex due to abnormally shaped body parts. Given the vast range of maladies, physical and emotional, which they cure, who can blame surgeons for feeling self-congratulatory, for feeling like a cross between a father confessor and sorcerer? “A young woman from Bastar came with an ugly birthmark that stretched from her neck to her abdomen. She was so affected by it initially that she would not even make eye contact with my staff. Now, she works as an interior designer in Mumbai,” smiles Dr Kalda, leaning back in his chair. For him and his peers, the anecdote is remarkable not because an underclass Adivasi woman is now designing homes in Mumbai, but because her post-op appearance made this possible.

So perhaps it’s not too eerie to meet Preeti, 19, in the waiting room a few hours later. Petite, fair and well heeled, Preeti is not worried about finding a husband. She is the daughter of a reputed Raipur jeweller and is accompanied by her boyfriend Jiten Yadav, a 20-year-old local mechanic. “Ever since I was young, I’ve always thought I could do with a better nose. It just doesn’t look right,” she says, angling her face to highlight what is ‘wrong’ with her delicate nose. (Interestingly, Dr CV Subbareddy of Visakhapatnam believes demands for nose-jobs are increasingly beginning to rival the local favourite, tummy tucks). Preeti suggests Dr Kalda lengthen it by half an inch to accommodate her future plans of getting braces on her teeth, which will alter her ‘face shape’. On examination, the doctor assures her she can get a sharper nose but there’s no need to lengthen it. And instead of braces, which take two years, she can get her teeth surgically straightened by him in two hours.

Then and now Satisfied customers (left to right) flaunt a nose job, a better facial profile, a chiselled look and a little dimple

But before Preeti can get up to leave, Dr Kalda suggests an additional nip and tuck for her chin, since noses and chins must align perfectly — obviously. The girl pauses. She’s never seen anything wrong with her chin. As the words come out of his mouth, her hand darts to her face and she swivels to the mirror. “What’s wrong with my chin? Is it too fat? What do you think?” she asks Jiten. The lover, who in a different story could have allayed her insecurities with a few words, perhaps accepted her for who she was, in spite of (or even for) her minute imperfections — he with his long nose and crooked teeth — looks at her and nods seriously.

NARGIS, 42, is a curious Raipur mother who has taught her daughter she had no need to ever wear a purdah but that she must always wear full-sleeved clothes. “I know my daughter is beautiful,” says Nargis, exchanging an identical smile with Bilquis, “but the world is not. Until today, even her closest friends don’t know that she has a scar on her arm.” Bilquis, 20, was injured as a child when her arm caught on a broken gate and an exposed nail left a vicious scar on her flailing forearm. “I’ve always loved adventure. Ma and Abba told me not to try and climb that gate but that’s exactly why I had to. I used to stay awake at night wondering what lay on the other side,” she laughs. Now a second year BSc student at Raipur University, Bilquis didn’t have much trouble keeping her scar concealed because her friends expected her to dress ‘conservatively’ — she was Muslim, after all. It became a private game to hide The Scar — she would come home and tell her mother how she was almost exposed during a hot day at school or while playing basketball at college.

A week before arriving at the clinic, the night when her nikaah was decided, she privately thanked Allah because she would now be able to wear T-shirts and short-sleeved kurtas like the rest of her friends. Her husband would know and there’d be no need to hide herself anymore. It was then that her parents announced their engagement gift for her — plastic surgery to permanently remove The Scar. In the clinic, mother and daughter talk in excited whispers — neither realising that Bilquis’ husband will never truly know his wife — that she’d been obsessed with exploring places as a child, that she hurt herself but discovered the other side anyway, that she’d spent her entire childhood worrying someone would see the most imperfect and most inimitable part of her.

The western tyranny of fulfilled perfection that surgeons preach so vigorously can be subverted. Bilquis might benefit from the example of Indian-born chef, model and author, Padma Lakshmi. The exquisite Lakshmi had a car accident at age 14 which left a seven-inch-long caterpillar scar crawling up her elbow. Her adolescent shame for the mark eventually turned to pride as she learnt to see her body and scar as a “map of her life”. Photographers and the media heralded a ‘real’ goddess instead of a plastic doll, a live woman with flesh and blood stories.

The stories of the plastic world are most often of beautiful, intelligent and spunky young girls who never knew there was anything wrong with them. These women who once knew a world beyond mirrors were taught it was wrong to choose their personalities over their appearance. If we are looking for a warning against turning plastic, it is right here — in the sugary dreams of a happily-ever- after.

Sarita, the fifth of Sukhbir Pal’s seven daughters in Korba, knew she was her parents’ favourite because her father always called her his ‘only son’, his sher. Pal let Sarita hang around his electronics shop and fiddle with the equipment because she found school ‘too boring’ and dropped out after class X. For the last 10 years, Sukhbir Pal and his wife have been marrying off their daughters in twos. This year, when Sarita turned 22 and her younger sister finished school, neighbouring families began approaching the Pals with prospective grooms. “They asked my elder sister to bring me to the room,” remembers Sarita. “I came in and my prospective saas stood up and walked towards me. I thought she was going to embrace me. I smiled, but she held my face by the chin and turned it, saying, ‘Ladki ke chehre pe daag hai (There’s a mark on the girl’s face).’ They left without further explanation.”

As Sarita describes the next few days — her father’s rage, her weeping mother — her elder sister Roopam’s eyes mist over. They are both at Dr Kalda’s clinic at their shortfather’s behest. Pal says he will be damned if another family finds fault with his daughter. The solution, then, is to get the ‘flaw’ — a small dark brown crescent on her cheek, present from birth but too insignificant until now — removed by laser surgery. After marrying off four daughters proudly, Pal had to ask his bank for a loan for Sarita’s surgery, which costs Rs. 2 lakh.

Ask her if she’s now scared and she says, “The doctor says it’s a small and quick surgery. I’m not worried, I’ve fallen and broken my limbs lots of times. But he did tell me that I can’t go out into the sun or the scar might reappear. Do you know anything about that? How can I not go into the sun, it’s everywhere… even in your city, even the richest women with the biggest cars, they can’t totally avoid the sun, can they?” As she’s wheeled into the operation theatre she winks at her sister and says “Oh didi, dulhe ko bhi check kar lo jaa ke, us ke upar bhi daag hai toh saath surgery karwa le! (Go get the groom checked too, if he has a scar as well we can get surgery together!)” An unamused Roopam explains, “She is young. She doesn’t understand — it doesn’t matter if a man is scarred or ugly, he will still get a wife. But a woman must do all she can to make herself the ideal wife. Our father loves Sarita too much, that’s why he wants her to be as beautiful as she can be.”

Three hours later, Sarita walks into the office for her follow-up prescription. Her sister and brother-in-law are waiting. Sarita holds her dupatta to her face, suddenly conscious of the raw pinkness of the wound where the scar once was. Her eyes are downcast. The perpetually smiling mouth is pursed. She refuses to look at anyone.

Between racing from one operation theatre to another, Dr Kalda often offers laddoos from the several mithai boxes patients send every day. His place and power in Raipur’s social life must be a strange and surreal experience. “Last night,” he recounts, “I attended a patient’s wedding — she’d come to repair a flat nose and get her skin lightened by a few shades. Her parents proudly told the guests that the only reason she was getting married was because I had given her a new life.”

Over subsequent days, Sarita continued to be downcast and subdued. Something changed when her family made their favourite daughter believe she needed to be changed for a man. When they let her be wheeled into that operation theatre alone, facing a stranger and a machine that burnt away a part of her skin and her days in the sun. This was a new scar that could not be erased.